- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $5.50 / $13.18 / $40.74
| Facility | | $5.50 | $13.18 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.75 / $5.01 / $10.47
| Professional | | $2.75 | $5.01 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.89 / $5.89 / $5.89
| Professional | | $5.89 | $5.89 | $5.89 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.47 / $14.13
| Facility | | $7.08 | $10.47 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $6.31 / $7.08
| Professional | | $5.25 | $6.31 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3.02 / $11.48 / $18.20
| Facility | | $3.02 | $11.48 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.74 / $4.90 / $9.77
| Professional | | $1.74 | $4.90 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4.47 / $6.17 / $7.41
| Professional | | $4.47 | $6.17 | $7.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $14.13
| Facility | | $7.08 | $7.08 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $7.08 / $8.32
| Professional | | $7.08 | $7.08 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $11.22 / $19.05
| Facility | | $7.08 | $11.22 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $6.31 / $8.32
| Professional | | $6.31 | $6.31 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $7.08 / $10.47 / $18.62
| Facility | | $7.08 | $10.47 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $5.25 / $6.31 / $7.08
| Professional | | $5.25 | $6.31 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $6.31 / $8.32 / $8.32
| Facility | | $6.31 | $8.32 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $4.17 / $7.08
| Professional | | $1.95 | $4.17 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3.63 / $3.63 / $4.79
| Professional | | $3.63 | $3.63 | $4.79 |